Scary questions.

I'm having a difficult day. For some reason, I woke up 'on edge' early this morning-- remembering my potentially low egg reserve as soon as I opened my eyes. I've spent most of the morning feeling as though I'm swallowing back tears, and I can't stop obsessing about the future of my fertility. This is what my Acupuncturist calls 'spinning', and in times such as these, I need to work extra hard to get out of my own head, to control the crazy, embrace the calm.. but easier said than done.

In a previous post, I mentioned that is recently came to light that the hubs and I aren't on the same page about having a baby right now. This realization is unbelievably...  everything! Frustrating, saddening, stressful, scary, heart breaking... If doctors are putting my fertility on a time table and the hubs isn't on board, where does that leave me? I'll tell you where.. pondering very scary questions.

Can I 'let go' of having a second child?

If I can't 'let go', how will I cope?

How long will I resent my husband for not at least trying to have a second child?

Am I willing to spend the rest of my life in a relationship with someone who doesn't want the same things I do?

I really struggle with these. Some days I wake up stronger than others, more empowered, and think,

There is no way I'm menopausal. It doesn't run in my family. I had a miscarriage last year, it was traumatic, and my body is still recovering. And if that's not the case, and my eggs are gone, we'll deal. I'll live happily ever after with my one child. It's not so bad. Just wait until he's older and we can pick up and travel at a moment's notice.

Other days, I am weak and pathetic:

I'm 32 years old and my eggs are gone. I was on birth control pills for 17 years-- what happened to all of those eggs I didn't produce?! I waited until everything was in-place before having a child because I thought I had a long fertile future and look at me... 32 and tests suggest menopause. My son will never have a sibling, he'll never cherish the strong sibling bond, such as I have with my brother. I will forever feel heartache and sadness with every pregnancy and birth announcement I hear. The miscarriage will always haunt me as that was my last chance for a second baby and my body failed me. How many nights will I talk myself out of taking Percoset to quiet the noise in my head so I can sleep? If there is still time to have a baby, how can I convince my husband we're ready?? 

I recently read something on Twitter that I'm kind of using as a mantra right now:

Let go of the many reasons why you can't, and hold tightly to one reason you can. Maybe I should write that 100 times.

Rage.

The past couple of weeks have been.... challenging. I have serious 'Doctor Rage'. Last time I wrote, I had just had a visit with my GYN for a second opinion. I left that appointment with the understanding that she was interested in my case; that she was going to spend some time reviewing my history (lab results/ultrasound results); and that she was going to consider some additional testing for my 'condition'. I also understood to expect a phone call from her about which labs to complete before our next appointment. So after a few days past, and I hadn't heard anything, I called the GYN's office to get the scoop. Typical response: "I'll leave a note for the doctor to call you". No call. So I call the lab to see if they have received any orders for me: nope. Another few days pass, still no word, so I call the GYN again. Same response: "I'll leave a note for the doctor to call you". Still no call.

When I show up to my follow-up appointment, the conversation goes something like this:
Receptionist: Did you do your labs?
Me: uh, no. I called here twice about that and got no information. And the lab didn't have any orders for me.
Receptionist: Hmm.. well before I take your co-pay, let me go check on that.
Me: Well, I need to see the doctor today. My husband took off work to attend this appointment so he could hear the discussion with the doctor.

I paid my co-pay. And when the nursing assistant called me back, she asked if I brought my prior medical records!! WHAT?! YOU all were supposed to get those! I signed release forms last time I was here! You mean, these whole two weeks, the doctor hasn't been reviewing my history?!! So they called my OB right then, had my file faxed, and asked ME to hand them to the doctor during our visit.

Several minutes later, picture me and my husband quietly waiting in a patient exam room, the doctor walks in and says, "Okay, why are we here today?" With a tight throat, I said, "remember, we spoke a couple of weeks ago. My hormone levels are outside normal range. My FSH is 28":
Doctor: Oh, right, well that's why you're not having your period.
Me: No. I have my period.
Doctor: Oh, well that's why you aren't ovulating.
Me: No. I'm ovulating.
Doctor: Let me look at these labs real quick.
(several painful minutes pass)
Doctor: If these results are accurate, they suggest that you are going through menopause.
Me: I know.
Doctor: I need to refer you to a Reproductive Endocrinologist.

Seriously?! You couldn't tell me this two weeks ago?! I'm on a time table here, you just wasted my time, and my money!! I'm furious!

By some miracle, I was able to get in to see the Reproductive Endocrinologist (RE) the very next morning. What a different experience! I wish my OB would have referred me to one back in November when my hormone levels were first observed out of normal range! The office is all inclusive, meaning if they need bloodwork, they do it there-- or if they need ultrasounds, they do them there! And the doctor talks to you IN HIS OFFICE! What a concept! Across from a desk, not in the patient exam room! The doctor who took my case is very nice. He's an older man, Dr. R. He used to head up the Reproductive Medicine Dept. at University of Florida. I haven't had a male doctor in a long time; while it's somewhat awkward to be 'felt up' by an older man, it's kind of refreshing. And I need that right now.

Dr. R ordered blood work. He wanted to re-test all of my hormone levels. And additionally, he performed an ultrasound. HE did, not a technician. During my ultrasound, he noted that my right ovary, the one I recently ovulated from, had very few follicles, like 1 or 2-- when they should see 6-10. This might indicate low egg reserve. Most of my blood results are in (with the exception of the tubes sent to CA for genetic testing), the blood was taken on CD 10, similar to my results in November so I have something to compare them to:

FSH: 4.7 (29.4 in November 2012)
E2: 88 (21 in November 2012)
LH: 3.4 (not taken in Nov 2012)
AMH: <0.16 (not taken in Nov 2012)

I'm SHOCKED at the difference in FSH scores! Even in January, my FSH test was 28!! So that all appears to be great news. However, AMH- Anti-Müllerian hormone was much lower than the doctor expected. This particular hormone (according to Dr. Google) gives an estimate of ovarian egg reserve and 'normal range' is >1.0. Dr. R felt my recent blood profile is conflicting and wants me to test on my upcoming CD3. I'm expecting my period to start any day now, which means I could test as soon as this week. 

Funny thing about my period this cycle: I ovulated an full 7/8 days sooner that what's typically 'normal' for me. Typically, I ovulate around CD 15-17, this cycle, I ovulated on CD7-- RIGHT after my period ended. Very strange. I had a horrible cold, so could it have been due to all the cold medication I was taking? Could that had also influenced the super low AMH score?! 

After those two days, I was an emotional wreck going into my Acupuncture appointment on Wednesday. I asked for the 'big guns' for stress and anxiety. Of course, I didn't know the results of the blood work then (I found out those results yesterday), but being frustrated with my GYN visit, and my husband and I not being on the same page concerning having another baby right now (whole other story!!!), I simply needed help. And I still do. All of these things are very scary: the doctor visits, the discussions at home, the impending doom of being menopausal at age 32! I even asked Dr. E (Acupuncturist) to borrow back the Randine Lewis book, "The Infertility Cure" just to help calm myself. and I saw my Primary Care Physician yesterday to talk about emotional health resources and she gave me some names of counselors to call. 

And, with all of these things going on in my life, none of which I can control, I took up something I can control. Wheatlessness. Wheat free eating. And that, too, is a conversation for a different. day.                     

All In.

Having one foot in Western Medicine and the other foot in Eastern Medicine has been (and continues to be!) an emotional roller coaster.

The West Side: After my second round of lab work (and the incompetence of my OB), I scheduled a second opinion with a GYN-- I met with her last Monday. She didn't have all my records from my OB, but based on the numbers I gave her, she told me to take the results very seriously. The lab results do suggest I have Premature Ovarian Failure (POF), and me taking these results "very seriously" means that I (we) should abandon all pregnancy prevention efforts because if I want to have a second child, this might be my only chance, if it isn't already too late. Very worrisome news. POF means menopause. At age 32. Menopause. And if this is in fact an accurate diagnosis, I will need to consider bone density scans and mammograms- because with menopause, comes risks associated with osteoporosis and breast cancer. The GYN and I talked about my lab work, and also the ultrasound I had performed back in November. She asked me if I ever saw it.. no. But the OB said it was 'normal'. But the same OB also said my most recent lab results were 'normal' which was far from accurate. So was the ultrasound actually 'normal'?! Needless to say, my OB will be surrendering all of those records to my GYN for further investigation. And the GYN wants to send me for additional testing. Apparently there is an autoimmune disease, where your body (by some influence-- even something as simple as a new food allergy!) produces antibodies that trick your hormones into a false menopause. The bottomline is, the GYN needs to see all of my records, and the additional test results so that we can figure out a plan forward. Which may or may not include her referring me to a specialist.

So obviously I left that appointment feeling very depressed. I felt that I needed to start preparing my self to accept a path that I would have never chosen for myself. In other words, I needed to accept that my toddler son may be my one and only. Not an easy feat. And what's more, I needed to go home and have a conversation with the hubs about our fertile future. If now is our only chance, he needed to be aware and get on board! That conversation was tough to approach, but I told him everything I know. He was nervous about my serious tone about us needing to talk, and at the end, he said it was a lot of information to process and he needed to think.. which in my mind means he needs time to worry about money and affording another kid. Sigh, men. We'll need to continue our conversation, but we have some time. It's not like we can go home and make a baby tonight; my ovulation phase has already occurred this cycle. But I think it would be value added if he attends my next GYN appointment with me so we can listen and talk with the doctor together.

The Western Doc was very honest according to my lab results, but here's what I gained from the Eastern Doc:

The East Side: I recently completed 9 sessions with my Acupuncturist and the two of us had high hopes that with the little time we've had together, we would see a positive influence in my test results. No suck luck. Although we have seen his influence positively affect my cycles. They are now a standard length, no break through bleeding, bi-phasic basal body temperature shifting-- all good stuff! He knew the emotional state I was in when I arrived-- angry, sad, frustrated, anxious-- pretty much all negative without an ounce of optimism. So he prepared for our session with a compilation of literature and data for POF patients. First and foremost, he re-emphasized that in the Chinese Medicine, lab tests are certainly helpful, however, TCM care should concentrate on the Patterns first. For instance, women with POF have the following symptoms: vaginal dryness, hot flashes, night sweats, two consecutive FSH scores >40, no period or very short cycle, no ovulation... I, on the other hand, do not have any issues with vaginal dryness (quite the opposite, actually!), no hot flashes, no night sweats, both of my FSH scores have been 28/29, my cycles are 32 days with confirmed ovulation around CD 16.. so my patterns doesn't match my lab results. What does that mean?? Dr. E continues to feel very confident and optimistic that my body is experiencing a miscommunication.

So I left this appointment feeling very optimistic and positive about my situation. An emotion 180 degrees different from the feelings I had leaving the GYN. The good news is that my Western GYN and the Eastern Acupuncturist have a history of working together and respecting one another's practice. I feel like Western Docs take a 'plan for the worst, hope for the best' approach based soley on science and statistical data, but Eastern Docs--  they take a more holistic approach with a much reduced concern for science and statistical data and emphasis on actual symptoms or lack thereof. And about my lab results-- you know I never had these levels tested before conceiving my son.. I really wonder if they were in 'normal' range, or if my FSH has always run high. I mean, if I had had these same charts back in November, I would have never thought to see my OB with concerns...

Where to start.

I got my results back. Not good news. I called my OB for them last Monday, Tuesday, and Wednesday, but because the OB hadn't reviewed them or signed off on them, they weren't able to release them. So I waited. Until Thursday. The conversation went something like this: 

Tech: All your hormone levels are in normal range. 

Me: Really?! Great! What are the numbers??

Tech: FSH is 28. 

Me: Wait.. what?! 8 weeks ago that number was 29 and you told me that was ‘elevated’. And isn’t that number supposed to be below 10??

Tech: uh… I’m gonna need to leave a note for the doctor. 

Me: What is my estrogen?

Tech: 15. 

Me: That number was 21 before and you said that was low. Now it’s 15?? How is that normal????

Tech: I’ll leave another note for the doctor.

Three days later and I'm still waiting to hear from that OB. 

I wasted no time on Thursday making an appointment with a different doctor. A GYN. She doesn't deliver babies but specializes in womens health issues. I was seeing her back in 2009 until I became pregnant with my son; she's honest and thorough. Just what I need. I think. I spent an hour with her this morning going over my history and recent labs. She fully agrees that my results are not "normal" and is very concerned. Being frank, these results suggest perimenopause and a rapid decline in fertility. Although she's sending me for additional tests, she says we need to take these results "very seriously", so serious, in fact, that we shouldn't waste anymore time preventing pregnancy. ::crickets::

Seriously?! I'm 32 years old!! My mother didn't go through menopause until her mid- 50's. My grandmothers were having babies into their 40s! I should have another 20 years before having to touch this subject! :( 

But here I am. Preparing myself to have the conversation of a lifetime with my husband. I'm terrified. I can already hear him saying, "I don't want another baby", "we can't afford another baby"... But here I am. On the clock. This might be our last chance.. if it already isn't too late. 

Last Thursday.

I’m nervous today. Like when I was in school and I knew I’d be hearing about my grade on a big paper I had to write or a tough exam. I’m anxiously waiting to hear back from my OB about the blood test I took last Thursday. It was a follow up test to the one I took the week of Thanksgiving last year that came back telling me *premature ovarian failure* *menopause* and *infertility*. The prognosis to those results was ‘test again in 6 weeks’ and although the first week of the new year marked 6 weeks, my Acupuncturist requested that I wait and test on the 3rd day of my cycle.. which was last Thursday.

I’m nervous because I really want to hear that my hormone levels have returned to a normal range. I want to hear that estradiol is high and FSH is low. We also tested LH, but I’m not sure what a normal range is for that hormone. What if they haven’t improved though? What if they are still imbalanced? I will be more accepting if they are unbalanced yet better than previous results.. but what if they’re worse? How will that news affect me?

Dr. E has been very supportive in the weeks leading up to this follow up blood test. He confidently reinforces the fact that less than ideal results are not a bad thing. The blood test will give him data that he can then use to ‘course correct’. The data will either confirm that what he’s doing is right and working, or tell him he needs to tweak his methods. I respect his logic, and have reminded myself of his perspective several times over the last few weeks when I need something to control the crazy.

I’m actually feeling optimistic. Last month’s cycle was very nearly normal: it was biphasic showing a rise in BBT post ovulation; ovulation was confirmed on CD17 by both OPK strips and the post ovulation BBT rise; my cycle lasted 33 days which is much improved from the previous 40 day cycle; the cycle had a 14 day luteal phase with BBTs staying above the coverline. I only have a few concerns: although I had plenty of fertile fluid, my cervix was not high and open on the day I ovulated; and I spotted a few days before my actual period flow started.  Dr. E feels very strongly that my body is experiencing some sort of miscommunication, and that acupuncture will help reset/reboot everything. And I feel very passionate that the 9 sessions we’ve had together so far have been doing nothing but good things! I no longer have any breakthrough bleeding, my anxiety is better managed, my periods aren’t as painful, and this last cycle being so nearly normal speaks for itself! So hopefully all these good things will bring me good news today or soon! 

The Infertility Cure.

A few sessions ago with Dr. E, he prescribed me some homework. He recognizes that his strict instructions on me not maxing out my cardio exercise efforts at the gym handicaps my ability to cope with stress and anxiety and wanted to give me something to help compensate. A book to read: The Infertility Cure, The ancient Chinese Wellness Program for getting pregnant and having healthy babies, by Randine Lewis.

Two sentences into the introduction and I was hooked. Hooked in the sense of 'OMG, I could have written this book. I am this woman, and this woman is just like me!!' So I kept reading. Randine talks about having a healthy baby, and several years later, attempting to have another but ending up suffering a miscarriage instead (me). Her yearning to have another child grows into an obsession (me). She takes pain pills to numb the emotional pain (me, again). And then she goes into how she turned Traditional Chinese Medicine (TCM) to completely transform her reproductive system, and as a result had a healthy baby boy months later (I hope this will be me someday!).

There are several different chapters included in the book, all with the same overlying Mantra, "Infertility is a Myth". For my situation, this book has been invaluable.There is a whole chapter on Premature Ovarian Failure, POF, that has brought me much comfort in that I am experiencing none of the normal symptoms associated with this condition. It has offered me hope beyond hope with every case study presented; and as a result I feel I can better communicate with Dr. E. Anyone experiencing any form of infertility (which is a myth!) should pick up this book.

This is 2013.

Not quite how I pictured it. I certainly didn't picture myself still nursing the wounds of a lost pregnancy. And I definitely didn't see myself regularly seeing an Acupuncture Therapist to sync up an epically unbalanced hormonal system.

On New Year's Day, we went to the movies and saw This is 40. Lots of laughs. Just what the doctor ordered. Literally. One interesting part of the story though, was the references to Eastern Medicine. The lead female character believed in Traditional Chinese Medicine, or TCM (<-- more on that later) so much so that when her young daughter had an ear infection, her eastern medicine practitioner was the first one she called for help! Then you learn that TCM miraculously shrunk a large thyroid gland that had once promised infertility, and a pregnancy resulted. As sensitive as I am to pregnancy success stories, I appreciated the reference to Eastern Medicine and it's help in achieving a positive result. It makes me feel comforted and optimistic about my own reproductive future. 

Yesterday, I had my 6th session with Dr. E. At my 4th session, I arrived very emotional. I was on cycle day 38 with no signs that ovulation had occurred and no signs or symptoms that my period was coming; and no possibility of pregnancy. He comforted me, explained to me how he felt my chart and current status was a good thing, and said that he was going to place some 'extra' needles to 'jumpstart' my body into starting a period. That afternoon I had menstrual cramps, with a very heavy period starting at 1am the next morning!!

During our session, he also explained to me that my first period while under Acupuncture Therapy would be different that any period I've ever had. He told me to expect very heavy flow, rich dark red blood, clotting and maybe more pain. I'm soooo glad we had that talk because ALL of those things happened!! Heaviest period of my life! It was over in 4 days (opposed to the normal 7 days). Lots of clots and 'old' material. He described that flow to be cleansing, and I agree.

Yesterday's session was much more mellow. We're feeling optimistic about my chart this week. I have signs/symptoms that my body is preparing to ovulate. My waking temps are grouped nicely. Since the start of this new cycle, he prescribed I take a formula of Chinese herbs, they come in a vitamin called Maternal Health. He wouldn't tell me how the supplement may or may not affect the chart because he doesn't want me to obsess about it, which I can definitely appreciate. So now I'm just taking one day at a time. Each day awarding me with another data point unlocking the mystery to fixing a really fucked up game of 'telephone' between the major players of my reproductive system.